SEROUS DIATHESIS-ASCITES-DROPSIES.
Among the morbid phenomena which are the result of disturbances of the circulating system, must be mentioned first the dropsies of pregnant women, which have their seat in the cellular tissue, and may extend even to the great serous cavities. Stolz and his pupils Thierry, Lauth, Schindler, wished to make one morbid entity., and have classed all these phenomena under the name of serous diathesis, serious cachexia of preg nant women, and of the recently confined woman.
We believe, for our part, that they have gone too far in this matter, and that the dropsies which occur in pregnant women, and those lately confined, are only the manifestation of a general state, in which, it is true, the altered state of the blood is the chief cause, but which, apart from this altered blood state, may be produced by a group of causes in dependent of each other. In our opinion there is a great difference between dropsies which may occur during pregnancy, and those which manifest themselves after confinement, and we admit, completely, the division which Raymond has given of the puerperal state; minor and major puerperal state. For us, it is impossible to compare precisely the condition of a woman during pregnancy and that of a woman after confinement. During pregnancy, a,s Pajot has said, all tends to hyper trophy, afterward all to atrophy. And although the puerperal period, in our opinion, commences with conception, only to finish after confine ment, according to all authorities the true puerperal state commences only after the confinement, or better still after the labor, and it impresses with a peculiar gravity all the affections, which, happily, rarely affect women during pregnancy. Besides, this is what is shown by. the study of the works of Lauth, Thierry, and Thirion de Namur; because their observations referred almost always to those women recently confined. There may be a relation between dropsies which occur during pregnancy and those which occur after labor; this fact is unquestionable, but in this last case the puerperal period plays the chief part.
Assuredly we do not question the considerable influence in the production of these dropsies played by the altered state of the blood in pregnant women, so weli studied to-day, both in quality and quantity; but the diminution of the albumin does not sufffce to explain all the dropsies of pregnant women, and of those recently confined, and we do not believe that the cachexia, the serous diathesis of pregnant women or of those recently confined, can be considered as a true morbid entity.
If it were so, all pregnant women would. in different degrees, present these dropsies, and they constitute, on the contrary, the exception, chiefly in their serious forms.
We cannot accept then, as absolutely true, the definition of Schindler: "The serous cachexia of pregnant and recently confined women, is pro duced by a general or partial dropsy of the cellular subcutaneous tissue, by extravasation into the serous cavities, or by the infiltration of the interstitial tissue of vital organs, all united to diminish the albumin of the blood during pregnancy." The pupils of Stoltz themselves are not all agreed, because, while Thierry admits a serous diathesis, Lauth and Schindler admit serous e,achexia. We refer to the thesis of Lauth for the history of the subject.
Scanzoni, who designated this condition under the name of serous eachexia, affirmed that "this state of the blood, common in pregnant women, gave rise to a serous exudation, often abundant in the serous cavities (pericardium, pleura, peritoneum), in the cellular tissue under the skin Eind sub-serous tissue (lower extremities, vulva and vagina), in the parenchyma of some organs (lung and brain, even to a transuda tion into the cavity of the amnion (hydramnion), and into the internal walls of the uterus (hydrorrhcea). This condition endangers the life of the mother and child. Its influence during pregnancy deserves the more attention, because to it is added the pressure exercised by the distended uterus on the neighboring organs.
"Thus, pulmonary ceclema, effusion into the pleura and into the pericardium, become more serious, because of the obstacle which the uterus presents to the dilatation of the thorax. Thus the cedema of the lower extremities and the genitals is increased by the pressure on the pelvic vessels, often to such an extent that motion becomes impossible, and the distension of the skin is extremely painful." Devilliers and Regnauld, who have especially studied dropsies of the cellular tissue, have divided them into two great classes. hit. (Edema or anasarca, which may be simple or involve the organs of respiration and circulation. 2d. CEdema or anasarea with albuminuria.